50 Schools / 50 States Proposal Form
First Name:
Last Name:
Position:
School:
Email:
Phone Number:
Type of School (Please Place an X after your selection)
- School for the Visually Impaired
- School for the Hearing Impaired
- Grade School
- High School
- College
- University
- Other
Is this a private or public school?
Address:
City:
State:
Zip Code:
Website:
Proposed Date or Dates:
Proposed Time or Times:
Focus of the Program (Please Place an X after your selection)
- Immersive: 
- Informative: 
- Inspirational / Motivational: 
Location of Presentation (Please Place an X after your selection)
- Auditorium: 
- Gym: 
- Classroom: 
- Meeting Room: 
- Other: 
We typically bring our own Audio / Visual Equipment, but if you have any of the following available, please place an X after what you have on-hand:
- No A/V Equipment: 
- Projectors: 
- Projector Screen: 
- Speakers: 
- Microphone: 
- Podium: 
Will there be an audio visual technician available if A/V support is needed:
How do you think our visit will benefit your school:

Additional Comments:

Please email this form to info@blindendeavors.org
End of form